Mail To: Mule Creek State Prison
Attn: Visiting Staff
P.O. Box 409099
Ione, CA 95640

(209)274-4911
www.cdcr.state.ca.gov
www.cdcr.ca.gov/Facilities-Locater/MCSP

STATE OF CALIFORNIA
VISITING QUESTIONNAIRE
CDC 106 (Rev. 01/03)
DEPARTMENT OF CORRECTIONS

READ CAREFULLY. Please PRINT or TYPE. The information requested will be used by officials of the California Department of Corrections (CDC) to determine whether your questionnaire will be approved or disapproved. The information provided will be maintained in a file pertaining to the inmate.

In accordance with the Privacy Act of 1974 (PL93-579), providing your Social Security number is optional. However, any omission or falsification on this questionnaire may be cause for denial of visiting. Please mail this form directly to the visiting office of the institution where the inmate is confined.

1. NAME OF INMATE YOU WANT TO VISIT (LAST FIRST MIDDLE)
GOEHLER WILLIAM ROBERT

INMATE'S CDC NUMBER
K-77832

2.YOUR NAME (Print your name exactly as indicated on the photo identification you will be using)

SUFFIX (Jr., Sr., etc.)

HOME TELEPHONE NUMBER
( )

3. MAIDEN NAME (if applicable)

HAVE YOU EVER USED ANOTHER NAME? IF SO, PLEASE LIST

RELATIONSHIP TO INMATE: (Spouse, Son/Daughter, other)

4. DATE OF BIRTH (Mo/Day/Yr)

AGE

GENDER (Check one)
MALE FEMALE

BIRTHPLACE (City County State Country)

5. ID NUMBER

ID TYPE (Check one)

DRIVER'S LICENCE
STATE ID
MILITARY ID
USINS CARD
MCAS
PASSPORT

OFFICIAL USE ONLY EXPIRATION DATE:

ISSUED BY (County State Country)

6. SOCIAL SECURITY NUMBER

7. CURRENT RESIDENCE ADDRESS: STREET ADDRESS Apt.#(If Applicable)
CITY
STATE
ZIP CODE

8. MAILING ADDRESS: (If different from Residence Address)
CITY
STATE
ZIP CODE

9. PREVIOUS ADDRESS WITHIN PAST TWO YEARS: Apt.# (If Applicable)
CITY
STATE
ZIP CODE

10. ACCOMPANYING MINOR(S) (If Any): NAME, DOB, RELATIONSHIP TO INMATE
1. 2. 3.

10. Continued
4. 5. 6.

11. HAVE YOU EVER VISITED ANOTHER INMATE(S) IN A CALIFORNIA PRISON?
(Check one) YES NO If YES, complete Item 11A. Attach additional sheet(s) if more that two inmates.

11A. INMATE NAME
CDC NUMBER
INSTITUTION WHERE YOU VISIT INMATE
RELATIONSHIP TO INMATE
1.
2.

12. HAVE YOU EVER BEEN DETAINED, ARRESTED, OR CONVICTED OF A CRIME?
(Check one) YES NO If YES, complete Item 12A. List all detentions, arrest and/or convictions. Failure to list all requested information may result in denial of visiting. Attach additional sheet(s) if necessary.

12A. OFFENSE
APPROX. DATE
DISPOSITION: (Dismissed, Probation, Jail, Prison)
COUNTY
STATE

13. ARE YOU ON PROBATION
(Check one) YES NO If YES, answer 13A

ARE YOU ON PAROLE OR CIVIL ADDICT OUTPATIENT STATUS?
(Check one) YES NO If YES, answer 13A

HAVE YOU BEEN INCARCERATED IN A STATE ADULT/JUVENILE CORRECTIONAL FACILITY?
(Check one) YES NO If YES, READ 13B

14. ARE YOU CURRENTLY UNDER ANY TYPE OF COURT IMPOSED PROGRAM?
(Check one) YES NO If YES, please explain on additional sheet and attach to this form.

13A. TYPE: (Court, Formal, Informal, etc.)

SUPERVISING AGENCY

NAME, ADDRESS, AND TELEPHONE NUMBER OF YOUR PROBATION/PAROLE OFFICER:

COUNTY
STATE

13B. If you were discharged from an institution or discharged from parole or outpatient status within the last twelve (12) months, you must have prior written approval of the Warden before visiting will be permitted. You will also need to provide a copy of your discharge paperwork.

CONTINUED ON BACK PAGE

15. If you are under 18 years of age and are not an emancipated minor or the inmate's legal spouse, you must have the written notarized consent of a parent or legal guardian and be accompanied by a responsible adult who is also approved to visit. The notarized written consent must be presented each time a minor visits unless prior approval has been attained from the Warden for an inmate to visit with his or her unchaperoned children.

16. VISITORS WITH DISABILITIES: If you have special requirements related to your disability (medical implants, prosthetic devices or requiring mobility assistive devices, i.e., crutches, walkers, braces, wheelchairs, battery operated or custom prescribed wheelchairs, guide dog for the visually or hearing impaired, insulin kit with syringes, etc.) you will need to attach a verifying statement from your physician. Visitors with guide dogs will need to provide the dog's certification paperwork upon visit check-in. The CDC will make every effort to provide reasonable accommodations for all qualified/eligible visitors with disabilities in keeping with the safety and security of the institution and the public. If you have any questions and/or concerns, please contact the institution where the inmate is confined.

17. The following laws relate to prison visitation:

SUBJECT TO SEARCH: Visitors entering the correctional institution, camp or facility grounds are subject to a search of their person, vehicle and property. Except as described below, visitors may leave the institution, camp, or facility grounds rather than submit to a search of their prison, vehicle or property. Refusal to submit to the search will result in denial of visiting for that day.

Visitors may not elect to leave the correctional institution, camp or facility grounds rather than submit to a search when institution officials possess a court issued search warrant or cause for a search arises while the visitor is on the institution grounds and the cause for the search is believed by institutional officials to be a criminal offense.

FIREARMS AND DRUGS ON INSTITUTIONAL GROUNDS/ASSISTING INMATES TO ESCAPE: It is a felony for anyone to assist inmates to escape. Bringing firearms, deadly weapons, explosives, tear gas, drugs, drug paraphernalia, or selling drugs on prison grounds, or giving/selling inmates firearms, weapons, explosives, liquor, cocaine, or other narcotics or any kind of drugs, including marijuana, is a crime (Sections 2772, 2790, 4534, 4535, 4550, 4573, 4573.5, 4573.6, 4573.8, 4573.9, 4574, 4600, California Penal Code).

GIVING LETTERS TO INMATES OR TAKING LETTERS OUT FOR INMATES BY ANYONE IS A MISDEMEANOR: (Section 4570.5, 4571 California Penal Code).

FALSE IDENTIFICATION: Anyone who falsely identifies himself/herself to gain admittance to a prison is guilty of a misdemeanour. Persons previously convicted of a felony in the State who came upon the grounds of a prison without permission of the official in charge are guilty of a felony (Section 4570.5, 4571 California Penal Code).

TRESPASSING: Entry on institution property for unauthorized purposes will be considered trespassing as provided in Section 602(j) of the California Penal Code. Refusal or failure to leave the property when requested to do so by an official will be considered trespassing as provided in Section 602(p) of the California Penal Code.

PERIOD OF EMERGENCY: In the event of an emergency situation that affects a significant portion of the inmate population at an institution, the visiting program and other program activities may be suspended during the period of emergency (Section 2601(d), California Penal Code).

GIVING OR REVEIVING GIFTS: Giving or receiving gifts to or from inmates is a misdemeanour (Section 2540, 2541, California Penal Code).

HOSTAGES: Hostages will not be recognized for bargaining purposes during attempted escapes by inmates (Section 3304, California Code of Regulations, Title 15, Division 3, Chapter 1).

18. If you are APPROVED to visit, the inmate will be notified and it is his/her responsibility to notify you.
If you are DISAPPROVED to visit, the institution will notify you by mail. You will not be allowed to visit until your application is approved.

I have read and understand the above information and agree to follow all Federal, State and CDC rules and regulations.

VISITOR SIGNATURE DATE

VERIFICATION OF MAILING
I have mailed this Visiting Questionnaire to the visitor applicant.

W Goehler K-77832
INMATE SIGNATURE/CDC# DATE

OFFICIAL USE ONLY-TO BE COMPLETED BY INSTITUTION STAFF
Criminal History: NO YES CII/FBI #

APPROVED
DISAPPROVED, for the following reason(s): (IF DISAPPROVED, the applicant and inmate are to be informed in writing of the disapproval.)
Omissions and/or falsifications Section(s): Need copy of Declaration of Discharge
Need disposition(s) for:
Applicant is under: parole formal probation Civil Addict Outpatient supervision
Arrest record received via DOJ indicates applicant has an extensive and/or recent history of criminal activity for offenses that are particularly sensitive to the institutional security. May reapply after: (DATE: )
Other:
Applicant's privileges to visit will be reconsidered:
upon receipt of the above requested information and/or after (DATE: )

PRINT NAME
SIGNATURE
TITLE
INSTITUTION
DATE

INMATE/VISITOR NOTIFIED ON (DATE) BY WHOM

Freedom Anywhere June 2017, page 3

Free as a Bird by Roger (Hari) Feit

Years ago, my wife and I went to a library lecture by an ornithologist, a scientist who studies birds. He showed slides of beautifully colored birds that he had taken over his lifetime. You could easily tell that he loved the study of birds...it was his deep passion and he shined when he talked about them.

I had been introduced to bird watching by my wife at the time. She was a nature girl and especially got off on birdwatching. She was an artist by profession and was paid to do many drawings for nature journals. She learned her craft (under the wing) of a world renowned ornithologist. It was a lasting gift that she gave me. My favorites are birds of prey, especially hawks and falcons. I always carry my binoculars in my truck and pull off the road to watch an interesting bird that I spotted. I have seen eagles, peregrine falcons and many types of hawks close up and personal many times. It never gets old for me.

Crows seem to follow me everywhere. One day after meditating I looked out my window to see what was making such a racket. It was three crows serenading me. I thanked them and asked them to fly up to the window and say hi. When the first crow did just that I was frankly surprised and somewhat befuddled, but when the next two took their turns to fly within a few feet of where I was standing I knew I was experiencing a sign from Source.

Another time, while I was walking my dog, three crows followed us as we rounded the block. That same day I had to go to Staples, so off I drove in that direction. As I passed the edge of town three crows flew across the road in front of me. I thought about this for a while as I drove to Staples. When I got there, I got out of my car and looked straight ahead for Staples. I wasn't quite sure where it was located in this shopping center, for I hadn't been to this store in a while. Then I heard a weird noise coming from west of where I was standing. I looked in that direction. It was a crow making a different noise (almost like the cry of a seagull) from any I had heard before. He was squawking, pierced on top of the Staples sign over the entrance. I walked to the entrance and did my salutations and passed under him. For some reason I thought he was going to drop a poop on me just to be funny, but he didn't.
Continued on p.4

Meditation Mantra - ancient Hindu mantra
Om namah Shivaya. Om Salutations to the one who makes everything a blessing.

Freedom Anywhere June 2017, page 4
Free as a Bird, continued

Getting back to the lecture, the speaker was taking questions from the audience. A young girl asked "Why do birds sing? His answer was a simple one. Birds sing because they like do.

I once read that birds are here to remind us to connect to joy...to Bliss...to Source.

And what about the flying thing? Who of you haven't imagined what it must be like to fly? How cool would that be...such freedom!

Well, those are my current birdbrain thoughts. Send me your bird stories so I can share them with my readers. Until then, always be ready to stop for beauty and grace wherever you find it. Make a choice in your early morning regime to spot beauty that day. The more you do, the more you will find it...the more joy and good you will bring into being.

Don't miss out on the day's bounty...enjoy.

Think deeply about what's been said here. Read this a few times and write down ways you can get started.

Makes some changes. Take some baby steps each day to notice beauty and feel joy.

Are There Birds on Your Yard?
Do you know what kind of bird it is? Can you see a nest?

Inmates and Birds
In His Majesty's Prison on the Isle of Wight in the United Kingdom, prisoners serving life terms are allowed to buy birds, such as parakeets, canaries and parrots to keep in their cells to keep them company.

Bird Man of Alcatraz, Richard Stroud

Robert Franklin Stroud (January 28, 1890 - November 21, 1963), known as the "Birdman of Alcatraz", was an American federal prisoner and author who has been cited as one of the United States' most notorious criminals.[1][2][3] During his time at Leavenworth Penitentiary, he reared and sold birds and became a respected ornithologist, but because of regulations, he was not permitted to keep birds at Alcatraz, where he was incarcerated from 1942 to 1959. Stroud was never released from the Federal prison system.

Stroud began serving life in solitary confinement at Leavenworth, where in 1920, after discovering a nest with three injured sparrows in the prison yard, he began raising them, and within a few years had acquired a collection of some 300 canaries. He began extensive research into them after being granted equipment by a radical prison-reforming warden, publishing Disease of Canaries in 1933, which was smuggled out of Leavenworth and sold en masse,[4] as well as a later edition (1943). He made important contributions to avian pathology, most notably a cure for the hemorrhagic septicaemia family of diseases, gaining much respect and some level of sympathy among ornithologists and farmers.

Order Print Preview Page 1 of 1

Golden State Care Packages, INC.
212 E. Rowland St #424, Covina, Ca 91723
Phone: (866) 387-9030 - Fax: (844)709-5337
INVOICE

Order #: R07QWLJGJ Quarter: 2nd Qtr - from April 1 to June 30, 2017
Date: 5/3/2017 8:39:00 AM
Institution: Mule Creek State Prison, LVL 1,3,4
Mule Creek State Prison
4001 Highway 104
Ione, CA 95640

Additional Items
# Description Qty Unit Price Extended Tax
1 myster23TC - Mackerel, 4 Jerky, Cin, Noodle, Rice, Alu 1 $0.01 $0.01
2 23032 - Chicken Of The Sea Pink Salmon Pouch 6 oz 7 $3.45 $24.15
3 420002 - Kam Yen Jan Chinese Style Cured Pork Strips 10.2oz 3 $7.95 $23.85
4 mgb04 - 22023 VAR OATMEAL 6pk, 22010 CIN TST CRUNCH 1 $1.95 $1.95
5 212056 - Spam Single 3 oz 10 $1.40 $14.00
6 360016 - Oscar Mayer Ready to Eat Bacon Strips 2.52 oz 2 $6.85 $13.70
7 28211 - Cotton Swabs 100ct Clear Canister 1 $1.45 $1.45
8 28548 - Pantene 2 in 1 Shampoo & Conditioner 12.6oz 1 $6.75 $6.75
9 23203 - Oscar Mayer Real Bacon Bits Hickory Flavor Added 2 $3.95 $7.90
10 28908 - Centrum Silver Multivitamin for Adults 50+, 80 Tab 1 $11.95 $11.95
11 350008 - California Sausage Spicy Pork 16 oz 3 $9.95 $29.85

Shipping Charges $6.95

SUB:YES.
Sub-Total $142.51
Discount ($0.00)
Credit ($0.00)
Sales Tax $0.00
Grand Total $142.51

Package Weight (Oz) 290.00

Entered By: EMMA

PRINT CLOSE

Hail the fecund Lord and Lady, and father Hler. I am on fire with energy and power. My vigour propels me forward. Thank you. Be blessed in you blessings and Fare The Well.
Noblesse Oblige.

https://goldenstatecp.com/office/ORDERS/OrderPrint.asp?OrderID=R07QWLJGJ 5/4/2017